(Boston) June 25, 2010 – Thousands of Boston-area home health patients on Medicare, and thousands more across the state, stand to lose necessary services as a result of a poorly managed new federal regulation.

A provision in the Patient Protection and Affordable Care Act published recently by the Centers for Medicare and Medicaid Services (CMS) states that, as of July 6th, home health agencies will be prohibited from submitting claims for reimbursement from physicians who have not enrolled in a new online system. Failure to register in the Medicare Provider Enrollment, Chain and Ownership System, or PECOS, would also block these physicians, who can still see Medicare patients, from referring new patients for Medicare-covered home health services.

At issue is that CMS has not adequately educated physicians about this new requirement. The result is that as many as 50% of physicians in Massachusetts have not registered on PECOS. Moreover, the registration and approval process can take several weeks, so even if physicians were to register immediately, their status would not be approved by the July 6 deadline.

“CMS has waived the usual comment period and imposed, with almost no notice, this ill-conceived regulation, erroneously alleging that it poses no burden for Medicare providers,” said Home Care Alliance of Massachusetts executive director Patricia Kelleher. “The experience of agencies who sought to verify physician enrollment in this new system is that it is cumbersome and time-consuming as many agencies work with hundreds of different doctors.”

Indications are that most physicians are not even aware of this new administrative burden. An analysis by the Visiting Nurse Association of Boston, which is one of the largest providers of services in the region, is that two-thirds of their referring physicians have yet to register.

“The Visiting Nurse Association of Boston cares for more than 6,700 Medicare patients annually, and that excludes those served by the myriad of other home health providers in the area,” said President and CEO of The Visiting Nurse Association of Boston, Reynold Spadoni. “With the effective date rapidly approaching, we believe that this new ruling has unfairly placed the burden of physician compliance squarely on the shoulders of the very patients it intends to help. Many of the elderly, chronically or seriously ill patients cared for by the Visiting Nurse Association of Boston and other home health providers will be placed at risk for losing their services, due to this ruling.”

“The federal government needs to delay this baseless regulation,” Said Kelleher. “The last thing our health system needs is another barrier keeping very sick and homebound patients from getting home health care.”

The Home Care Alliance of Massachusetts and the VNA of Boston, along with countless other home health agencies and advocacy organizations across the Commonwealth and country, are urging the Centers for Medicare and Medicaid Services and Congress to delay implementation of the rule until such time as physicians have ample time to enroll and also to hold harmless the home health providers that will suffer from the abrupt transition.

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I began this blog in 2009 after joining the Visiting Nurse Association of Boston & Affiliates. This is a forum to relate comments and experiences on the health care industry (and specifically home health care), photography, technology and other topics of interest. Thanks for visiting.